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Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy

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dc.contributor.author Johansson, Kjell Arne
dc.contributor.author Robberstad, Bjarne
dc.contributor.author Norheim, Ole Frithjof
dc.date.accessioned 2011-04-29T08:28:22Z
dc.date.available 2011-04-29T08:28:22Z
dc.date.issued 2010-01-16
dc.identifier.citation AIDS Research and Therapy 7:3 en_US
dc.identifier.issn 1742-6405
dc.identifier.uri http://dx.doi.org/10.1186/1742-6405-7-3
dc.identifier.uri http://hdl.handle.net/1956/4719
dc.description.abstract Background International HIV guidelines have recently shifted from a medium-late to an early-start treatment strategy. As a consequence, more people will be eligible to Highly Active Antiretroviral Therapy (HAART). We estimate mean life years gained using different treatment indications in low income countries. Methods We carried out a systematic search to identify relevant studies on the treatment effect of HAART. Outcome from identified observational studies were combined in a pooled-analyses and we apply these data in a Markov life cycle model based on a hypothetical Tanzanian HIV population. Survival for three different HIV populations with and without any treatment is estimated. The number of patients included in our pooled-analysis is 35 047. Results Providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2.0 and 0.7 life years respectively. Conclusions This study demonstrates that HIV patients live longer with early start strategies in low income countries. Since low income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART. en_US
dc.language.iso eng en_US
dc.publisher BioMed Central Ltd en
dc.rights Copyright 2010 Johansson et al; licensee BioMed Central Ltd. en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title Further benefits by early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy en_US
dc.type Peer reviewed en_US
dc.type Journal article en_US
dc.rightsHolder Johansson et al. en_US
dc.type.version publishedVersion en_US
bora.cristinID 341300


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Copyright 2010 Johansson et al; licensee BioMed Central Ltd. Except where otherwise noted, this item's license is described as Copyright 2010 Johansson et al; licensee BioMed Central Ltd.

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